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WO1999013780A1 - Clamp d'occlusion et applicateur pour clamp d'occlusion - Google Patents

Clamp d'occlusion et applicateur pour clamp d'occlusion Download PDF

Info

Publication number
WO1999013780A1
WO1999013780A1 PCT/US1998/019234 US9819234W WO9913780A1 WO 1999013780 A1 WO1999013780 A1 WO 1999013780A1 US 9819234 W US9819234 W US 9819234W WO 9913780 A1 WO9913780 A1 WO 9913780A1
Authority
WO
WIPO (PCT)
Prior art keywords
plunger
occlusion
channel
distal end
clamp
Prior art date
Application number
PCT/US1998/019234
Other languages
English (en)
Inventor
Cathy Aranyi
Robert J. Desantis
Richard Yagami
Original Assignee
United States Surgical Corporation
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by United States Surgical Corporation filed Critical United States Surgical Corporation
Priority to AU94863/98A priority Critical patent/AU9486398A/en
Publication of WO1999013780A1 publication Critical patent/WO1999013780A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • A61B17/1227—Spring clips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
    • A61B17/128—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord for applying or removing clamps or clips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/30—Surgical pincettes, i.e. surgical tweezers without pivotal connections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac

Definitions

  • the present disclosure relates to an occlusion cla ⁇ and applicator for applying the occlusion cla ⁇ to body tissue. More specifically, the present disclosure l o relates to an occlusion cla ⁇ and applicator having few moving parts particularly suited for coronary bypass procedures.
  • occlusion clamps are used during a variety of surgical procedures to isolate an area which requires surgical repair. For example, during coronary artery bypass grafting occlusion clamps are used to isolate the heart and the coronaiy blood vessels by placing an occlusion clamp on the ascending aorta. Occlusion clamps are also used extensively during neurosurgical procedures to isolate a cerebral aneurysm from the
  • Such known occlusion clamps and applicators for applying occlusion clamps to tissue are complex and are susceptible to inadvertent separation of the occlusion clamp from the occlusion clamp applicator.
  • U.S. Patent No. 4,367,746 to Derechinsky discloses an applicator for applying clips to blood vessels.
  • the applicator includes a rectilinear tube having a coaxial
  • the distal end of the rod includes a hook adapted to support a clip.
  • a handle and operating mechanism are connected to a proximal end of the tube and rod and are operable to reciprocate the tube relative to the rod.
  • the tube and rod are biased relative to each other such that a clip supported on the hook is partially retained within the tube in a compressed and open position. Upon actuation of the applicator, the tube is
  • an occlusion clamp and an o applicator for applying the occlusion clamp to body tissue is provided.
  • the occlusion clamp applicator includes a housing having a proximal end having a first opening, a distal end having a second opening, and a pair of finger gripping members extending radially outwardly from the exterior of the housing.
  • the housing defines a channel which extends between the first and second openings.
  • a plunger is partially positioned within the channel 5 and extends through the first opening.
  • the distal end of the plunger is operably connected to a jaw mechanism which is also slidably positioned within the channel.
  • the jaw mechanism includes a pair of resilient shank portions, each having a distally located jaw member which extends through the second housing opening.
  • Each shank portion also includes a cam surface which engages the distal end of the channel when the plunger is o retracted to move the jaw members from a position in spaced relation with each other to a position relatively close in relation with each other.
  • Each jaw member includes a slot having converging sidewalls which intersect at an apex. The slots are configured to support an occlusion clamp.
  • An occlusion cla ⁇ usable with the presently disclosed clamp applicator 5 includes a base portion and a pair of legs extending therefrom. Each leg includes a pair of parallel proximal portions, a pair of cross-over portions, and a pair of clamping portions. Each proximal portion includes a dimpled section configured to receive the converging sidewalls of the slot in the jaw members of the presently disclosed cla ⁇ applicator. When the jaw members are in the position in spaced relation with each other, the apex protrudes o slightly into the dimpled section of the cla ⁇ to prevent inadvertent separation of the clamp and the applicator. BRIEF DESCRIPTION OF THE D A I GS
  • FIG. 1 is a perspective view of one embodiment of the presently disclosed occlusion cla ⁇ and clamp applicator
  • FIG. 2 is an enlarged view of the distal end of the occlusion clamp and cla ⁇ applicator shown in the indicated area of detail of FIG. 1;
  • FIG. 3 is a perspective view with parts separated of the occlusion clamp and clamp applicator shown in FIG. 1;
  • FIG.4 is an enlarged view of the distal end of the jaw mechanism of the occlusion clamp applicator shown in the indicated area of detail of FIG. 3;
  • FIG. 5 is a top view of the occlusion clamp and clamp applicator shown in FIG. 1 with the top housing half-section removed, the jaws in a retracted position, and the occlusion clamp in the open position located about a vessel;
  • FIG. 6 is an enlarged perspective view of the distal end of the occlusion clamp and clamp actuator shown in FIG. 5;
  • FIG.7 is an enlarged perspective view of the occlusion clamp shown in FIG. 1;
  • FIG. 8 is a top view of the occlusion clamp and cla ⁇ applicator shown in
  • FIG. 1 with the top housing half-section removed, the jaws in an advanced position, and the occlusion clamp in the closed (clamped) position about a vessel;
  • FIG. 9 is a top view of the occlusion clamp shown in FIG. 7 disengaged from the clamp applicator and positioned about a vessel.
  • FIGS. 1 and 2 illustrate the presently disclosed occlusion cla ⁇ and clamp applicator shown generally as 10 and 12, respectively.
  • clamp applicator 12 includes housing 14, plunger 16 and jaw mechanism 18.
  • Housing 14 is formed having a pair of rearwardly located finger gripping members 20 and a forwaidly and a rearwardly 5 located opening 22 and 24 (FIG. 3), respectively.
  • Plunger 16 extends through rearward opening 24.
  • Jaw mechanism 18 is positioned within housing 14 and has a distal end which extends through forward opening 22 and outside housing 14.
  • the distal end of jaw mechanism 18 includes a pair of resilient jaw members 26 and 28.
  • Each jaw member 26 and 28 includes a slot 30 configured and dimensioned to engage the body of a cla ⁇ 10.
  • 0 Slots 30 have a pair of converging sidewalls 27 that intersect at an apex 29. See FIG. 4.
  • housing 14 is preferably constructed from molded half-sections 14a and 14b which are fastened together using pins and/or tabs 32 on one of the housing half-sections and identically configured openings 34 formed in the other of the housing half-sections. Tabs and/or pins 32 are snap-fit into openings 34 to secure the 5 housing half -sections together.
  • each housing half-section includes both pins 32 and openings 34 spaced along its periphery.
  • other fastening methods may be used to attach the housing half-sections together, e.g., adhesives, screws, sonic welding, etc.
  • Housing half-sections 14a and 14b define a channel within housing 14 which includes rearward channel portion 36 and forward channel portion 38.
  • Forward channel portion 38 o includes a proximal rectilinear section and a distal section that gradually increases in width toward its forward end, i.e., each sidewall defining channel portion 38 tapers outwardly towards the forward end of housing half-sections 14a and 14b.
  • Annular shoulder 40 separates forward and rearward channel portions 36 and 38.
  • Plunger 16 includes a cylindrical body portion having an annular flange 42 5 formed along a midsection thereof.
  • An actuator member 44 preferably configured for engagement with a user's thumb, is formed on a rearward end of plunger 16 and an attachment member 46 is formed on the forward end of plunger 16.
  • Attachment member 46 and/or actuator member 44 may be monolithically formed with plunger 16 or formed separately and attached thereto.
  • Attachment member 46 is configured to be fixedly received o within a correspondingly shaped interlocking slot 48 formed in the rearward end of jaw mechanism 18.
  • T-shaped other interlocking configurations are contemplated, e.g., bulbous tip.
  • Jaw mechanism 18 includes body portion 50 and a pair of forwardly extending resilient shank portions 52.
  • Interlocking slot 48 is formed in the rearward end of 5 body portion 50 and is configured to fixedly receive attachment member 46 of plunger 16, as discussed above.
  • Resilient shank portions 52 of jaw mechanism 18 extend forwardly from body portion 50 and are angled outwardly in an unbiased state.
  • Jaw members 26 and 28 are formed on the distal end of shank portions 52.
  • Each shank portion 52 also includes a cam surface 54 positioned to engage the forward end of forward channel portion 38.
  • the 0 distance between cam surfaces 54 in the unbiased state is greater than the width of the distal end of channel portion 38, such that when jaw mechanism 18 is retracted into channel portion 38, shank portions 52 are biased inwardly to move jaw members 26 and 28 from a spaced configuration to a configuration in which jaw members 26 and 28 are in a relatively closer relation.
  • plunger 16 and jaw mechanism 18 are positioned 5 within housing 14 such that annular flange 42 is slidably positioned within rearward channel portion 36 and jaw mechanism 18 is slidably positioned within forward channel 38.
  • Annular flange 42 has a larger outside diameter than the inside diameter of housing opening 24 such that engagement between annular flange 42 and the rearward end of channel portion 36 defines the fully retracted position of plunger 16.
  • a C-clip 0 56 is positioned about plunger 16 located, within channel portion 36 to abut annular shoulder 40.
  • Biasing member 58 which is preferably a coil spring, is positioned about plunger 16 in channel portion 36 between annular flange 42 and C-clip 56 to urge plunger 16 to the fully retracted position.
  • occlusion clamp 10 is preferably constructed from a 5 single length of spring wire deformed to a shape having a base portion 64, a first leg 66 extending from one end of base portion 64, and second leg 68 extending from the other end of base portion 64.
  • Each leg 64 and 66 includes a proximal portion 67 having a dimpled section 69, a central cross-over portion 70, and a distal clamping portion 72.
  • Proximal portions 67 are parallel to each other and perpendicular to base portion 64.
  • Dimpled o sections 69 are dimensioned to receive converging sidewalls 27 and 29 of slot 30 (FIG. 4) of jaw members 26 and 28 to facilitate proper positioning of cla ⁇ 10 between jaw members 26 and 28.
  • the distal end 73 of each clamping portion 72 is sharpened to permit penetration of clamping portions 72 through body tissue about a vessel 74 (See FIGS. 5 and 6).
  • the tips can also be semi-sharp, shaped as a chi
  • biasing member 58 urges plunger 16 to 5 the retracted position to retract jaw mechanism 18 into channel 38.
  • shank portions 52 of jaw mechanism 18 are located substantially within channel portion 38 with cam surfaces 54 of shank portions 52 in engagement with outwardly tapered walls 60 of channel portion 38.
  • jaw members 26 and 28 extend through opening 22 in housing 14. Because the distance between the cam surfaces 0 54 of shank portions 52 in the unbiased condition is greater than the width of the forward end of channel 38, shank portions 52 are urged inwardly to move jaw members 26 and 28 inwardly toward each other.
  • resilient shank portions 52 are advanced along channel portion 38 through opening 22 disengaging cam surfaces 54 from tapered walls 60 and allowing resilient shank portions 52 to move to their unbiased state and jaw members 26 and 28 to move apart to the spaced configuration as indicated by arrow "C" in FIG. 8.
  • apexes 29 in slot 30 extend slightly into dimple sections 69 to assist in retaining clamp
  • proximal portions 72 of occlusion clamp 10 move apart to allow clamping portions 72 of occlusion clamp 10 to move together to a clamped position as indicated by arrow "D" in FIG. 9.
  • applicator 12 can be slid over cla ⁇ 10. The force of clamp 10 about vessel 74 is sufficient to overcome the small frictional force required to disengage apexes 29 from dimpled sections 68.
  • plunger 16 is advanced to move the jaw members 26, 28 further distally of housing 44 to allow the jaw members to flex outwardly to a position spread further apart.
  • slots 30 of jaw members 26 and 28 can be slid downwardly over base portion 64 of clamp 10 in a direction parallel to proximal leg portions 67, as indicated by arrow "E" in FIG. 7, to position slots 30 of jaw members 26 and 28 in alignment with dimpled sections 69 of cla ⁇ 10.
  • the distance between apexes 29 of slots 30 in the outwardly flexed position is equal to or slightly smaller than the distance between the outer surfaces of proximal leg portions 67, such that even when the jaw members 26 and 28 are in the advanced spread apart position, as illustrated in FIGS. 8 and 9, clamp 10 is prevented from falling from between the jaw members. Plunger 16 is then released, thereby retracting jaw members 26 and 28 to the position illustrated in FIG. 5 to spread apart clamp portions 72. Clamp 10 can then be applied to tissue as described above.
  • Occlusion clamp 10 and clamp applicator 12 may be used to perform a variety of surgical procedures.
  • the occlusion clamp 10 and cla ⁇ applicator 12 may be used to perform a variety of surgical procedures.
  • each clamping portion 72 may be used to clamp the coronary artery during bypass surgical procedures. As illustrated in FIGS. 5, 6, 8 and 9, the sharpened end of each clamping portion 72 is positioned to penetrate tissue 83 located about vessel 74 to be clamped, e.g., coronary artery. By positioning clamp portions 72 in tissue 83 located about the coronary artery 74, tissue 83 acts as a cushion between clamping portions 72 and coronary artery 74 to prevent inadvertent vessel damage.
  • the plunger and the jaw mechanism can be monolithically formed.
  • the shape of the cam surfaces on the shank portions of the jaw mechanism and the shape of the forward channel portion in the housing may include any configuration which produces the desired result of moving the jaw members from positions in spaced relation to positions in relatively close relation. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended thereto.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Vascular Medicine (AREA)
  • Reproductive Health (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention a pour objet un clamp d'occlusion (10) et un applicateur (12) pour clamp d'occlusion qui sert à appliquer le clamp d'occlusion (10) à un tissu du corps. L'applicateur (12) pour clamp d'occlusion est constitué d'un boîtier (14) muni d'éléments de prise (20) pour doigts. Le boîtier définit un canal (38) qui relie les premier et deuxième orifices (34). Un piston (16) partiellement disposé dans le canal (38) passe à travers le premier orifice (34). L'extrémité distale du piston (16) est reliée de manière fonctionnelle à un mécanisme de pinçage (18), également disposé coulissant à l'intérieur du canal (38).
PCT/US1998/019234 1997-09-18 1998-09-15 Clamp d'occlusion et applicateur pour clamp d'occlusion WO1999013780A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU94863/98A AU9486398A (en) 1997-09-18 1998-09-15 Occlusion clamp and occlusion clamp applicator

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US08/932,685 US5928251A (en) 1997-09-18 1997-09-18 Occlusion clamp and occlusion clamp applicator
US08/932,685 1997-09-18

Publications (1)

Publication Number Publication Date
WO1999013780A1 true WO1999013780A1 (fr) 1999-03-25

Family

ID=25462727

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1998/019234 WO1999013780A1 (fr) 1997-09-18 1998-09-15 Clamp d'occlusion et applicateur pour clamp d'occlusion

Country Status (3)

Country Link
US (1) US5928251A (fr)
AU (1) AU9486398A (fr)
WO (1) WO1999013780A1 (fr)

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